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Oa/z6/20i6 TVE i2:az <br />(P) 425-257-8810 <br />FAx a252521666 CM xeating �003/003 <br />�ECTRICAL PERMIT A�ICATION <br />CITY OF EVERETT PERMIT SERVlCES <br />320Q C�DAR STRE�T, �VERETT, WA 982D1 <br />� FAX 425-257-8857 �(E) everetteps�everettwa.gov � www.everettwa.gov/permits <br />� � , . ' CON'TAC'Y' M��ORNVdTNON � <br />OWNER NAME: �} ' <br />OWNER MAILIN� ADDRESS <br />OWN�12 PHON�; ,� C <br />CONTRACTQR NAME: � <br />CONTRACTOR ADDRESB: <br />9TREET <br />GTY <br />97R62T <br />TENANT NAME <br />OWNER EMAIL: <br />9TATE `� V '1"i PIP <br />GITY \ \ � 3TATE ZIP_ `I�� <br />GONTRACTOR PNONE: O��� CONTRACTOR EMAII.. �P�"� � C��"�'n �� <br />CONTRACTOR LIC, # REqUIRED : Q5 CITY OF EVERETT 6USINES8 LIC, # REqUIRED : <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR Ca OTHFf2 (Plvase 5pe�lfy) <br />CONTAC7 NAME; CONTAC7 pHON�; (� <br />� � CONTACT EMAIL: <br />AaRE�M�NT: T hereby cort!(y that I hsve read and ex�minad ti�ls eppllcallon end know the same fo be true and c�rrecf, A!1 provls+ans vf laws and v�d�nances erning thfs <br />type ol work w!!f 6a oomp/alad whafhar spoaifred herein ar no�, Tha granting oia permlt does not preswr�e fo �tva authorlly fo vlolafe or oanoe! lhe provtslons ol any othar sfnle or <br />lo�sl f�w regGf�l�ng cvnsfruct/on or Ihe parformance o/ consfruc[lon, Thai I am autJtorizatl by 1hv ownar of l!,!a properiy fo perfo�m ths work for walch epplrcatron is mede �nd I <br />comply wlfh tlto Sfe�a Contractors Law 98.27 RCW and 29d.200 WAC. <br />Owner/Authorizad A�ent Slgnaturg p et <br />Gity of Everelf O/flcla! Use On1y <br />FEE <br />�� � <br />���„ / <br />PERMIT # <br />E I - � .�-� <br />(Rovlsod 10/12/2015) <br />